Provider Demographics
NPI:1417315508
Name:WAUGAMAN, BRENDA JANE (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:JANE
Last Name:WAUGAMAN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34789 HARDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-2891
Mailing Address - Country:US
Mailing Address - Phone:440-554-9210
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE # A120
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-9000
Practice Address - Fax:216-445-1035
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH292991-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics